Page 11 - 2018-19 Optimas Enrollment
P. 11
Optimas
DENTAL
Delta Dental of Illinois Find a Provider
Delta Dental’s plans give you access to the largest dental provider networks 1. Go to
in the nation. You have the option between a base and buy-up dental plan. In www.deltadentalil.com and
both plans, you have the freedom to choose any dentist. However, you will click the provider search
receive the deepest savings if you choose a Delta Dental PPO dentist. All link select “Find a Network
Delta Dental network dentists file claims for you and your family when you Dentist” from the drop down
provide your identification card—no paperwork for you! menu
2. Call 800.323.1743, say
Delta Dental of Illinois
Base Plan Buy-Up Plan “Dentist Directory” and
Out-of-
Out-of-
In-Network Network* In-Network Network* follow the automated
Deductible (Plan Year) instructions
Individual $50 $50 $25 $25 3. Call your dentist’s office and
Family $100 $100 $75 $75 ask if they are a participating
Coinsurance—Percent You Pay Delta Dental PPO or Premier
Preventive Services:
100%
100%
100%
100%
Exams, X-Rays, covered covered covered covered network dentist
Prophylaxis 4. Deeper discounts will be
Basic Services: Fillings, received at Delta Dental PPO
20% after
20% after
20% after
20% after
Oral Surgery, Root deductible deductible deductible deductible providers vs. Delta Dental
Canals
Major Services: Bridges, 50% after 50% after 50% after 50% after Premier providers
Crowns, Dentures deductible deductible deductible deductible
Plan Year Maximum (Per Person)
$1,000 $1,000 $2,000 $2,000
Orthodontist Services
Dependent Children 50% no 50% no 50% no 50% no
Adults deductible deductible deductible deductible
Orthodontist Lifetime $1,500 $1,500 $2,000 $2,000
Maximum
* Please note, if you see an out-of-network provider, Delta Dental will reimburse
according to the maximum allowable charge.
Dental Contribution Rates
This chart illustrates your weekly, bi-weekly, and/or monthly pre-tax
contributions for the Optimas dental plan.
Base Plan Buy-Up Plan
Bi-
Bi-
All Employees Weekly Weekly Monthly Weekly Weekly Monthly
Employee Only $4.67 $9.35 $20.25 $5.67 $11.34 $24.57
Employee + Spouse $10.52 $21.05 $45.60 $12.62 $25.25 $54.70
Employee + Child(ren) $8.99 $17.97 $38.94 $10.79 $21.57 $46.74
Family $15.46 $30.92 $67.00 $18.66 $37.32 $80.87
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DENTAL
Delta Dental of Illinois Find a Provider
Delta Dental’s plans give you access to the largest dental provider networks 1. Go to
in the nation. You have the option between a base and buy-up dental plan. In www.deltadentalil.com and
both plans, you have the freedom to choose any dentist. However, you will click the provider search
receive the deepest savings if you choose a Delta Dental PPO dentist. All link select “Find a Network
Delta Dental network dentists file claims for you and your family when you Dentist” from the drop down
provide your identification card—no paperwork for you! menu
2. Call 800.323.1743, say
Delta Dental of Illinois
Base Plan Buy-Up Plan “Dentist Directory” and
Out-of-
Out-of-
In-Network Network* In-Network Network* follow the automated
Deductible (Plan Year) instructions
Individual $50 $50 $25 $25 3. Call your dentist’s office and
Family $100 $100 $75 $75 ask if they are a participating
Coinsurance—Percent You Pay Delta Dental PPO or Premier
Preventive Services:
100%
100%
100%
100%
Exams, X-Rays, covered covered covered covered network dentist
Prophylaxis 4. Deeper discounts will be
Basic Services: Fillings, received at Delta Dental PPO
20% after
20% after
20% after
20% after
Oral Surgery, Root deductible deductible deductible deductible providers vs. Delta Dental
Canals
Major Services: Bridges, 50% after 50% after 50% after 50% after Premier providers
Crowns, Dentures deductible deductible deductible deductible
Plan Year Maximum (Per Person)
$1,000 $1,000 $2,000 $2,000
Orthodontist Services
Dependent Children 50% no 50% no 50% no 50% no
Adults deductible deductible deductible deductible
Orthodontist Lifetime $1,500 $1,500 $2,000 $2,000
Maximum
* Please note, if you see an out-of-network provider, Delta Dental will reimburse
according to the maximum allowable charge.
Dental Contribution Rates
This chart illustrates your weekly, bi-weekly, and/or monthly pre-tax
contributions for the Optimas dental plan.
Base Plan Buy-Up Plan
Bi-
Bi-
All Employees Weekly Weekly Monthly Weekly Weekly Monthly
Employee Only $4.67 $9.35 $20.25 $5.67 $11.34 $24.57
Employee + Spouse $10.52 $21.05 $45.60 $12.62 $25.25 $54.70
Employee + Child(ren) $8.99 $17.97 $38.94 $10.79 $21.57 $46.74
Family $15.46 $30.92 $67.00 $18.66 $37.32 $80.87
11
